Volume 19 Supplement 1

35th International Symposium on Intensive Care and Emergency Medicine

Open Access

Association between hemoglobin, cerebral oxygenation and neurologic outcome in postcardiac arrest patients

  • I Meex1,
  • K Ameloot1,
  • C Genbrugge1,
  • M Dupont1,
  • B Ferdinande1,
  • J Dens1 and
  • C Dedeyne1
Critical Care201519(Suppl 1):P430

https://doi.org/10.1186/cc14510

Published: 16 March 2015

Introduction

The safety of a restrictive transfusion threshold of 7 g/ dl applied in all critically ill patients can be questioned in postcardiac arrest (post-CA) patients since these are phenotypically clearly distinct. The aims of this study were to investigate the association between hemoglobin, cerebral oxygenation (SctO2) and outcome in post-CA patients.

Methods

A prospective observational study in 82 post-CA patients during hypothermia in the first 24 hours of ICU stay. Hemoglobin was determined hourly together with a corresponding SctO2 by NIRS and SVO2 in patients with a pulmonary artery catheter (n = 62).

Results

Based on 2,099 paired data, we found a strong linear relationship between hemoglobin and average SctO2 (SctO2 = 0.70 × hemoglobin + 56 (R2 = 20.84, P = 10-6)). Given the previously suggested SctO2 target between 66 and 68%, hemoglobin levels below 10 g/dl generally resulted in suboptimal brain oxygenation. Forty-three patients (52%) had a good neurological outcome (CPC 1 to 3) at 180 days post CA. There was a significant association between average hemoglobin above 12.3 g/dl and good neurological outcome (OR = 2.88, 95% CI = 1.02; 8.16, P = 0.04). In a multivariate model, this association persisted after correction for comorbidities and age by the modified Charlson score (OR = 2.99, 95% CI = 1.05; 8.53, P = 0.03). This association was entirely driven by results obtained in patients with an average SVO2 below 70% (OR = 17.55, 95% CI = 1.67; 184.41, P = 0.01).

Conclusion

There is a steep linear relationship between hemoglobin and SctO2 in post-CA patients with hemoglobin levels below 10 g/ dl generally resulting in cerebral desaturation. Average hemoglobin below 12.3 g/dl was independently associated with worse neurological outcome 180 days post CA. An interventional trial is necessary to investigate whether maintaining higher hemoglobin would improve outcome.

Authors’ Affiliations

(1)
ZOL Genk

Copyright

© Meex et al.; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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